The impact of the financial crisis on health systems and the delivery of health care

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1 1 1 The impact of the financial crisis on health systems and the delivery of health care Médecins du monde - Doctors of the World International Network Nathalie Simonnot Milan, October 14, 2015 Doroftei, aged 10, has not been vaccinated: «I still cannot go to school» Saint-Denis France Denis Rouvre

2 European Network to reduce vulnerabilities in health members reaching out to populations in the margins Network hosted by Doctors of the World funds DG Health - CHAFEA Main focus: mutual learning, improving quality of care and patient empowerment, common data collection, & raising awareness among health providers, academics, policy makers Target population: destitute nationals (inc. Roma), undocumented third-country nationals and EU citizens (inc. Roma), drug users, sex workers, etc. To contribute to decreased EU-wide health inequalities and to more responsive health systems that are better equipped to deal with vulnerability factors. quantitative and qualitative data collection among the partners for improving quality of service delivery and building a solid evidence base for advocacy accessible healthcare for people facing vulnerabilities.

3 3 Examples of key figures (2014 data) 3 Based on 41,238 social and medical consultations in 9 European countries (24 cities), with 23,040 patients n=310 pregnant women 54.2% had no access to antenatal care 58.2% came to receive care too late (after the 12 th week) n= 645 children vaccination rate for children, very low 42,5% Tetanus 38,7% Hepatitis B 34,5% MMR 39,8% Pertussis (Whooping Cough)

4 National experiences and health policy responses to the effects of the economic crisis 4 4 Example of Spain In April 2012, Royal Decree-Law 16/2012 on urgent measures to ensure the sustainability of the national health system and to improve the quality and safety of its services was approved 500,000 foreign nationals with no permit to reside abruptly deprived of health coverage (in practice also pregnant women and children) Increased out-of-pocket payments for medication for all A patchwork of different regional regulations, e.g. announced changes in Castilla-La Mancha, Extremadura, Calabria, Valencia and the Balearic Islands + Madrid municipality

5 5 National experiences and policy responses to the effects of the 5 economic crisis on health systems REDER Médicos del Mundo (Spain) a sample of 1,500 documented cases between 01/2014 and 07/2015 in 12 autonomous regions - Many cases of cancer (31), cardiovascular disease (38), degenerative muscular disease (14), other types of degenerative diseases (8) + 28 other life-threatening conditions if no treatment + serious mental health problems (27) minors and 78 pregnant women were denied access (despite the explicit exemption in the law) denials of emergency care provision (despite the explicit exemption in the law) - Regional responses to remedy to the situation created by the national RDL 16/2012 are not sufficient: 73% of documented cases came from regions with some form of healthcare coverage for the uninsured - 12% of the people seen came to ask help to understand the law + 22% were unaware of their right to a health card (when relevant) + 12% were denied a health card despite their right to get one (misinformed administration staff)

6 National experiences and policy responses to the effects of the 6 6 economic crisis on health systems Example of Greece 2.5 million people below the poverty line Almost a third of the population without coverage (OECD) Unmet medical care needs from 5.4% (2008) 9% (2013) Child poverty from 23% (2008) 40.5% (2012) 32% rise in stillbirths between 2008 and % nationals among MdM patients in Greece Huge open drug scene (e.g. sisa) and hardly any harm reduction programs, Greek prevalence for HCV at 1.87%. No access to treatment No guarantees in new MoU (e.g. 5 hospital fee)

7 National experiences and policy responses to the effects of the 7 7 economic crisis on health systems Example of Greece - The price of all off-patent drugs shall be reduced to 50% and of all generics to 32.5 % of the patent price; - Reduction of pharmaceutical expenses - Cuts in the funds for diagnostic tests increased out-of-pocket payments expected

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10 National experiences and policy responses to the effects of the economic crisis on health systems Example of France: positive measures despite the crisis - Repeal of the 30 entrance fee to AME for undocumented migrants in 2012; - 8.3% raise of the income threshold for applicants to free full health coverage (July 2013) thereby granting more than 750,000 more patients access to CMU / AME; - National parliament voted a law (04/2015) about the progressive generalization of the third-payer system, i.e. no more out of pocket payment for consultations

11 National experiences and policy responses to the effects of the economic crisis on health systems Example of Sweden In July 2013 a new law came into force that allows all children to access public healthcare free at the point of delivery. Adult undocumented migrants have obtained the same rights as asylum seekers: they can access healthcare that cannot be postponed, ante and postnatal care, family planning, termination of pregnancy and dental care that cannot be postponed, provided they pay the 6 fee for every visit to a doctor or dentist & 40 at emergency units. 15/04/2015 interim assessment report of the implementation of the new law: costs were 100 million SEK (10 million EUR) instead of 300M SEK (30 million EUR), but still many people not cared for

12 Cost of exclusion Regular access to hypertension prevention: cost-savings of around 9% in DE & EL, about 8% in SE (and much more looking at a timeframe of 5 years) Access to prenatal care may generate savings of up to 48% in DE and EL, and up to 69% in SE, over the course of two years.

13 13 13 How can the EU support this process? MdM urges Member States and EU institutions to: Ensure universal public health systems built on solidarity, equality and equity, open to everyone living in a European Member State, Patients facing multiple vulnerability factors need more protection in times of crisis (and xenophobia), not less All children residing in the EU should have full access to national immunization programs and to pediatric care. All pregnant women must have access to sexual & reproductive healthcare. Migration policies that do not endanger people s health!